Urogynecology is a medical subspecialty focusing on disorders of the female pelvic floor, urinary tract, and reproductive organs. A urogynecologist, also known as a Female Pelvic Medicine and Reconstructive Surgery specialist, is trained in both gynecology and urology, providing comprehensive care for complex conditions. These specialists manage issues such as urinary incontinence, pelvic organ prolapse, and chronic pelvic pain, which often significantly affect a woman’s quality of life. Understanding what happens during an appointment can help minimize anxiety and ensure a productive visit focused on diagnosis and treatment planning.
Preparing for Your Visit
Gathering all relevant medical information beforehand provides the specialist with a complete picture of your health history, including a list of all current prescription medications and any over-the-counter supplements. It is helpful to bring previous surgical reports, especially those related to the pelvis or abdomen, and any recent relevant test results.
The most specific preparation is often completing a voiding diary (or bladder diary) for several days. This diary records fluid intake, urination times and amounts, and any leakage episodes, providing objective data on bladder function.
Check with the office regarding the required state of your bladder upon arrival, as this is test-dependent. For some initial evaluations, you may be instructed to arrive with a comfortably full bladder. This is typically achieved by drinking 24 to 32 ounces of fluid about 60 to 90 minutes before the appointment. A full bladder is necessary for certain in-office tests, though some offices may only require a urine sample for analysis upon check-in.
The Initial Consultation and Detailed History
The first part of your visit is a detailed interview where the urogynecologist gathers context. They will ask you to describe your current symptoms, including the onset, severity, and specific triggers, such as coughing or exercise. It is helpful to discuss how these issues impact your daily routines and overall well-being.
The specialist will explore your past medical and surgical history, focusing on any prior pelvic or abdominal surgeries that may have affected the pelvic support structures. A thorough obstetric history is also taken, including details about past births, such as delivery method and any associated trauma. This information provides clues about potential causes of your current symptoms.
Questions will extend to lifestyle factors, including fluid intake, consumption of bladder irritants like caffeine, and bowel habits, since constipation can worsen pelvic floor symptoms. The physician may also ask about sexual function and any associated pain. Providing open and honest answers is important, as this detailed history is the foundation for an accurate diagnosis.
Specialized Physical Examination and Testing
Following the consultation, a physical examination is performed, starting with a general assessment of your body mass index and abdomen. The specialized pelvic floor examination is similar to a routine gynecological exam but focuses intensely on the supporting structures of the pelvis. This assessment is often performed in different positions, such as lying down and standing, to check for changes influenced by gravity.
During the exam, the physician assesses the strength, tone, and tenderness of the pelvic floor muscles. They will look for pelvic organ prolapse by asking you to bear down or cough, which reveals how organs like the bladder or uterus descend into the vaginal space. The degree of prolapse is often staged numerically to quantify its severity.
Specific in-office tests are often integrated into the physical exam to aid in immediate diagnosis. A common procedure is the cough stress test, where the physician observes for involuntary urine leakage when you cough vigorously with a full bladder. Another routine measurement is the post-void residual (PVR) volume, which involves inserting a small catheter or using a bedside ultrasound immediately after you empty your bladder to measure the amount of urine left behind. A high PVR suggests an issue with the bladder’s ability to empty fully.
Depending on the initial findings, the urogynecologist may mention the possibility of more advanced diagnostic tests, scheduled for a later date. These can include Urodynamic Testing, which uses catheters to evaluate bladder and urethra function, or a Cystoscopy, where a small camera is used to look inside the bladder. The goal of this initial exam is to gather objective data to begin formulating a treatment plan.
Reviewing Findings and Determining Next Steps
After the history and physical exam are complete, the urogynecologist will discuss the findings and provide a preliminary diagnosis. They will explain how the information gathered points toward a specific pelvic floor disorder. This conversation clarifies the underlying cause of your symptoms and addresses any questions you may have.
The specialist will then outline the various treatment pathways available, emphasizing a shared decision-making approach. Treatment options are generally categorized into three groups, beginning with the least invasive approaches. Conservative management often includes lifestyle modifications, such as dietary changes or fluid management, and a referral for specialized pelvic floor physical therapy.
Pharmacological options, such as medications to manage an overactive bladder, will be discussed if appropriate. If conservative and medical treatments have been unsuccessful, the physician will discuss surgical options for conditions like severe prolapse or stress incontinence, detailing the procedure and expected outcomes. The appointment concludes with scheduling necessary follow-up visits, further specialized testing, or referrals to other specialists.